Suchner U, Reudelsterz C, Gog C
Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Darmstadt, Darmstadt, Deutschland.
, Berlin, Deutschland.
Anaesthesist. 2018 Nov;67(11):879-892. doi: 10.1007/s00101-018-0502-x.
The approach in the clinical fluid management of the dying is still controversially discussed in specialist circles and also in the general population. In this article the importance of establishing the therapeutic indications is emphasized against the background of a lack of evidence. Options to achieve noninvasive objectification of assumed dehydration as well as assessment of the reversibility of the symptoms are shown and the importance of monitoring of all therapeutic actions is discussed. The pathophysiological foundation of reversible disorders of fluid homoeostasis are described and distinguished from the irreversible disorders leading to terminal dehydration. If clinically assisted hydration (CAH) is indicated, the hydration status must be assessed individually as well as in advance and all therapeutic measures must be constantly adjusted to the results of non-invasive monitoring procedures.
临终患者临床液体管理的方法在专业领域乃至普通大众中仍存在争议。本文在缺乏证据的背景下，强调了确立治疗指征的重要性。展示了实现对假定脱水进行非侵入性客观评估的方法以及对症状可逆性的评估，并讨论了监测所有治疗措施的重要性。描述了液体稳态可逆性紊乱的病理生理基础，并将其与导致终末期脱水的不可逆紊乱区分开来。如果需要进行临床辅助水化（CAH），则必须对水化状态进行个体评估和预先评估，并且所有治疗措施都必须根据非侵入性监测程序的结果不断调整。
